3 Important Ways Digital Innovation is Transforming Healthcare

 

Medical advancements are reaching new heights thanks to innovations in the healthcare tech arena. But what about how you as a plan sponsor and your employees are accessing healthcare to make the most of these advances?

Digital transformation is revolutionizing both direct-to-consumer and direct-to-employer healthcare offerings. Here are three ways digital innovation is transforming the healthcare sector, making it easier for employers — especially those with self-funded plans — and their employees to maintain wellness, reduce absenteeism, and minimize costs:

1. Technology is improving both employer and employee satisfaction.

A monumental outcome of the healthcare industry’s rapid digital transformation is its capacity to improve customer satisfaction. The best part? It does so at every level: individual patients are more satisfied with their coverage and providers, and plan sponsors also experience greater satisfaction with their self-funded plans.

At the employee level, advancements like patient portals and member self-service platforms make it easy for patients to schedule appointments, find in-network providers, refill prescriptions, receive test results, and communicate with their providers. Digitizing the intake process saves patients time and stress by allowing them to complete forms on their own time before their appointment. Virtual appointments make it much easier for patients with busy schedules to avoid time-consuming travel or those with children to arrange childcare.

But digitalization isn’t just increasing employee satisfaction for organizations opting for self-funded care — it is also saving them time and money. Annual health visits help patients recognize risk factors before they become larger problems. In addition, yearly vaccines, such as the flu vaccine, reduce the likelihood that patients will become sick and have to miss work. Through their TPA relationship, plan sponsors can now send push notifications to remind patients about their upcoming appointments and give nudges when it’s time to schedule an annual visit or vaccination. After receiving a push notification reminder, patients can even make appointments directly within their patient portal.

Furthermore, patients can use their portals to ask providers questions and request prescription refills. Digitizing these communications expedites care and eliminates the expense of an office visit.

Other technological advancements, such as fitness trackers and apps, encourage patients to be more engaged in their health — increasing the potential for healthier individual practices, such as regular exercise. According to a recent study, middle-aged patients who exercise regularly tend to save an average of $824 to $1874 on healthcare costs annually. Another study from the IQVIA Institute for Human Data Science suggested that apps and wearable devices could save the US healthcare system $7 billion per year. The data shows that patients who are more engaged in their health can often avoid escalation in medical care, further reducing absenteeism for employers.

2. Digital innovations allow companies to reimagine product development.

Digital innovations allow for greater customization of healthcare plans, as technology can now gather robust and accurate data to inform product development decisions. Technology-powered data analysis and greater transparency into employees’ benefits usage offer greater capacity for customization and greater potential that plans are cost-effective.

Self-funded plans featuring robust technology customization, in particular, are smarter than before, and are no longer just for large corporations. TPAs can collect data on how employees interact with their benefits and coverage. Empowered with this data, they can advise companies on how to make their benefit plans more cost-effective and more aligned with their employees’ needs. A technology-led quality TPA knows how to harness data to tailor each self-funded plan to its sponsor’s population and budget. For employers with complex needs, such as those with Minimum Essential Coverage (MEC) plans, technology is a true game changer, making it easier to track employees’ hours and keep accurate records.

Technology also enables TPAs and their clients to be proactive, leveraging employee usage data to drive participation in wellness initiatives. If employers notice a high incidence of diabetes or cholesterol medications, they may institute positive behavior modification programs, thereby promoting greater employee wellness while also inciting lower long-term medical costs.

3. Technology drives productivity.

In nearly every industry, technology is improving administration — driving productivity, reducing human error and omissions, and cutting costs by slashing manual repetitive tasks. The healthcare industry is no exception. Healthcare providers’ admin costs can be contained, if not lowered, as patients can now self-serve, accessing the information they need 24/7 from within their portals. Digitized patient onboarding eliminates the need for manual input, and lowers paper and storage costs. And with digitized files and forms, it is easier and faster to do any multitude of tasks, including locating files, sending bills, processing online payments, and much more.

Technology makes it easier for self-funded plan sponsors to:

  • Pay invoices and track payments
  • View open, pending, and paid claims
  • Automate enrollment
  • Handle eligibility by employee type, hours worked, and more
  • Collect employee hours
  • View statuses and run reports in real-time

And for their employees to enjoy similar ease, such as the ability to:

  • Check claim statuses
  • View benefits enrollment and details
  • Search for providers

In the hands of tech-led TPA, these digital advancements have the power to dramatically reduce administrative strain on plan sponsors, spur productivity, and significantly rein in costs.

Learn how MagnaCare’s innovative technology can transform healthcare for you and your employees.

MagnaCare’s award-winning advanced technology platform modernizes self-funded plan administration. As a TPA technology leader, we remove the burden of managing enrollment, benefits, and claims and create ease with one intuitive interface. With MagnaCare as the TPA, plan sponsors get customized and affordable plans and all the support they need to elevate their employees’ health and engagement. Contact us to learn more.

 

 

Decoding the Inflation Reduction Act: How the New Law Will Affect Self-Funded Plans

The Inflation Reduction Act (IRA) of 2022 is an expansive law that makes a few important policy changes to the U.S. healthcare system. Signed into law on August 16 as part of Biden’s Build Back Better Plan, elements of the IRA aim to reduce the costs of prescription drugs by tightening regulations on pharmaceutical companies providing medication to Medicare recipients. The healthcare portion of the law currently focuses on capping or lowering costs specifically for Medicare recipients, so employers may be left wondering how — or if — they’ll be affected by this new legislation.

Here we break down two of the most important features of the IRA, what they mean for healthcare costs, and specifically how they may affect self-funded plans:

1: What the IRA does for prescription drug costs: caps all out-of-pocket costs for Medicare recipients and allows Medicare to negotiate the prices of prescription drugs. 

Until now, Medicare has been unable to negotiate prescription drug prices with the private companies it contracts with as part of a “non-interference” clause. The new IRA will allow the United States Secretary of Health and Human Services to begin negotiating prices of 10 high-cost prescription drugs covered under Medicare Section D in 2026. These first 10 drugs will be selected and announced by Medicare in 2023. By 2028, 20 high-cost drugs will be up for price negotiation.

This component of the law is also designed to dissuade pharmaceutical brands from engaging in price gouging by requiring any company that increases the prices of their prescription drugs higher than the rate of inflation to pay a rebate to the government.

Furthermore, beginning in 2025, all Medicare beneficiaries, regardless of income, will enjoy a $2,000 cap on out-of-pocket prescription drug spending. Those who take insulin will see a $35 a month out-of-pocket spending cap on the medicine as early as 2023.

What this cap and negotiation means for self-funded plan sponsors:

Before the IRA became law, the government lacked the power to regulate much of drug pricing. Increased regulation will be a watershed change for pharmaceutical companies that have become accustomed to raising their drug prices faster than the rate of inflation, with no penalties for doing so. Because of this, some have expressed concern that pharmaceutical companies will attempt to make up for the lowered Medicare costs by charging employers more. On the other hand, as a result of the new pressure on drug companies and the penalties in place for price gouging, plan sponsors and their employees may see prescription drug prices begin to stabilize.

Widely affordable prescription drugs would be a huge boon for plan sponsors because the lower prices would likely bring down the cost of employer co-pays and help limit costly emergency doctor or urgent care visits incurred by lack of access to medication.

Let’s take, for example, the new out-of-pocket cap for insulin. According to Yale University, more than 7 million Americans rely on daily insulin, a notoriously expensive drug, the cost of which is currently rising faster than inflation.

In an earlier draft of the IRA, this insulin cap was meant to apply to all individuals taking insulin — including those under private, employer-sponsored plans. While it would have been a major win for plan sponsors, this part of the act was struck down before it ever became law, limiting the cap only to Medicare beneficiaries. Still, some believe that capping the cost of insulin for Medicare beneficiaries could curb the rising costs of the drug in the long term — ultimately stabilizing the cost of the drug for private plan sponsors as well.

2: What the IRA does for insurance plan subsidies: Extends ACA health insurance plan subsidies to 2025.

Originally meant to last only two years (2020–2021), the IRA extends temporary subsidies put in place by the American Rescue Plan Act to 2025.

The original subsidies reduced premiums for individuals who chose to purchase their health insurance coverage through state- and federal-run Affordable Care Act (ACA) marketplaces. The extension of the subsidies allows individuals to continue to afford their premiums within these plans.

What this subsidy extension means for self-funded plan sponsors:

At first glance, this section of the act may seem to apply only to individuals purchasing their own insurance, and not to employers. However, SHRM writer Stephen Miller encourages organizations with more than 50 employees to use this extension as an opportunity to verify that they are offering ACA-compliant healthcare coverage to their employees. With more individuals taking advantage of the subsidies to afford care, tax credit receipts may help the government identify and penalize organizations not offering proper employee care.

Employers can provide their employees affordable, ACA-compliant care through a customized, self-funded plan.

The bottom line: It literally pays to be strategic with your healthcare benefits plan.

While the IRA of 2022 is unlikely to affect plan sponsors in the short term, it’s possible that increased access to subsidies may mean the government will be more aggressive toward employers who are not providing ACA-compliant coverage to their employees. It’s also possible that out-of-pocket spending caps for Medicare recipients and penalties for drug companies engaging in price gouging may gradually stabilize prescription drug costs — potentially reducing employer co-pays and spurring wider access to necessary prescription drugs.

Plan sponsors looking for more immediate relief from the rising healthcare costs spurred by inflation may be able to save by switching to self-funded coverage. As an experienced and tech-forward Third Party Administrator, MagnaCare works with you to create a custom plan tailored to your workforce, budget, and needs, with ancillary benefits coverage and a case management program for employees with more complex needs. Plus, MagnaCare handles all administration from enrollment to claims processing. Contact us to learn how we can help you provide your employees with affordable quality care.

The Truth About Self-funded Health Plans: Debunking 5 Common Misconceptions

There are a number of misconceptions about self-funded health plans. Let’s set the record straight. Here are five truths you should know about self-funded plans:

Medical plan costs are projected to rise an average of 5.6% per employee in 2023. This is a sharp increase from the 4.4% projected for 2022. Many employers are already experiencing strain as their health insurance premium costs skyrocket. As a result, more and more plan sponsors are seeing the financial advantages of switching to self-funding for employee healthcare benefits. But some are still hesitant to make the switch due to common misconceptions.

As a TPA with 30 years of experience specializing in self-funded benefits plans, we’re here to clear up the most common misunderstandings about self-funded plans, (also known as self-insured plans), so you can have the facts when deciding whether or not to make the switch.

Preconception #1: Self-funded plans aren’t cost-effective.

Not true. Not only are self-funded plans affordable — they save plan sponsors money.

Many employers are under the impression that with self-funded coverage, they must produce large sums of money on the spot to cover their employees’ claims whenever they arise. In actuality, plan sponsors pay a set sum each month so that they already have money saved for when it comes time to pay a claim. This sum takes workforce size and employee needs into account, making it a flexible monthly rate that is affordable and realistic in terms of projected medical costs. Self-funded plans reduce a plan sponsor’s overall costs, immediately saving them 2 to 3% on the cost of their plan, with the potential to save more, a lot more.

Furthermore, with a self-funded plan, companies only pay for medical costs their employees incur. So, if a business’ healthcare bills come in under their premium payments, that’s money returned at the end of the plan year.

This is a huge difference between self-funded and fully-funded (also known as fully-insured) insurance plans. With a fully-funded plan, even if a company’s healthcare costs come in under budget, their insurance company keeps the entire premium — a fact that you are probably already painfully aware of. But with self-funded coverage, companies have the potential to get money back at the end of the year, helping them score major savings.

Preconception #2: Self-funded insurance plans are labor-intensive.

False. A quality TPA takes care of all administration for you.

Plan sponsors often think that when self-funding employees’ coverage, they’ll be tasked with more administrative duties. This is simply not true when you work with a quality Third Party Administrator (TPA). A TPA creates a company’s plan and then handles all administrative aspects, including enrollment, compliance, and ongoing correspondence with employees when they have questions about their benefits. Because of the wide scope of what they cover, partnering with a TPA dramatically cuts in-house administrative workload and costs.

Preconception #3: Self-funded health plans only make sense for large companies.

Nope. Medium-size businesses can reap the rewards of self-funded coverage, too.

All the aforementioned money and time-saving benefits of self-funded coverage apply to mid-sized companies at comparable risk levels since plans are tailored to a company’s workforce. With a custom plan, cost is predictable. Plus, mid-sized companies can instantly cut the operational costs of a self-funded plan by working with a TPA.

Preconception #4: Self-funded insurance plans are limited in the scope of their offerings and provide little flexibility.

Wrong. With an experienced TPA as your partner, self-funded plans can be flexible and fully customized.

If you’re under the impression that self-funded plans have limited offerings — which could lead to poor employee satisfaction and problems with retention – you’ve been misled. In actuality, a TPA will take a look at a business’ needs and map out a custom plan that’s both targeted to the plan sponsor’s employee base and cost-effective. For instance, if a company has many employees with young children, the plan can prioritize family care. Similarly, self-funded plans can affordably cover behavioral health needs and complex or chronic conditions. And self-insured plans can stay flexible as a plan sponsor’s workforce evolves.

MagnaCare’s innovative offerings, such as ancillary benefits coverage and a case management program for individuals with more complex healthcare needs, are built to ensure plan sponsor’s employees get the care they need at minimal cost to you.

Preconception #5: Self-funded insurance plans are simply too much of a risk.

Incorrect. The financial risk of a self-insured plan is comparable to the risk of fully-insured coverage. Plus, there are self-insured safeguards to mitigate risk.

By its nature, all insurance reflects risk. Yes, there is a marginal risk in self-funding employee health coverage: there is a chance that at the end of the year, a client may end up owing more money than they planned due to unexpected medical events. However, consider the opportunity risk of a fully-insured insurance policy: even though the plan sponsor knows their set cost for the year upfront, they lose out on money if their medical costs come in well below the cost of their premium.

There are also self-funded features to mitigate cost-exposure risk if an employee (or one of their family members) has a catastrophic medical event or diagnosis. A self-funded plan with a stop-loss policy protects a plan sponsor for being on the hook for unexpectedly and extraordinarily large medical bills.

 

Now that you know the truth about self-funded plans

As a full-service, nationwide TPA with 30+ years’ experience, MagnaCare is the expert in high-quality, low-cost, innovative self-funded solutions. We work with plan sponsors to create custom self-insured health plans tailored to their budget and the unique needs of their workforce. Then, we handle all the administration — from enrollment to eligibility to EOBs. MagnaCare even helps navigate employees to lower-cost, higher-quality providers, so they can get the quality care they need at a lower claim rate. Plus, our award-winning intuitive platform and mobile app keep plan sponsors and their employees fully in the loop. Contact us to learn more facts and how we can assist you.

 

 

 

 

 

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Media Contact:
Erin George
[email protected]
615-946-9914

Know before you go: Where’s the best place to go for an eye exam

Your eyesight is precious. Periodic eye exams are an important step in preserving your vision long term. In addition to correcting your vision, during an eye exam your eye doctor can detect any eye disorders at an early stage, when they are more easily treated and their progress can possibly be reversed.

But navigating eye care benefits can be confusing. The first thing to understand is that there are three different types of eye care providers: opticians, optometrists, and ophthalmologists.

Opticians have a 1- or 2-year degree certification, and specialize in filling lens prescriptions. Once you have your eyeglass prescription in hand, an optician will assist you with lens and frame selection and fitting. An optician is not qualified to conduct eye exams.

Both optometrists and ophthalmologists are qualified to conduct eye exams, where they will not only check your vision, but will also check your eye health for conditions such as glaucoma and macular degeneration.

What’s the difference between optometrists and ophthalmologists?

Optometrists are doctors of optometry (OD) with four years post-graduate doctoral training, and they can diagnose and treat certain non-complex eye conditions, including writing prescriptions. They cannot perform surgery.

Ophthalmologists are medical doctors (MD or DO) who went through four years of medical school plus specialized training in ophthalmology. They can diagnose and treat complex medical eye conditions and perform surgery.

Which should I go to for my eye exam, an optometrist or an ophthalmologist?

Doctors available through vision plans are usually optometrists. If you have a vision plan, it is usually better for you to go to a participating optometrist, for several reasons:

  • Optometrists specialize in eye exams for healthy people who may have some loss of vision, as usually occurs as we get older. That’s what they do all day, every day. It’s their area of expertise.
  • With most vision plans, you pay a lower copay than if you go to an eye doctor who is a medical doctor through your medical plan.
  • Importantly, many medical insurance plans will not cover your visit to an MD/DO eye
    doctor for the purpose of a routine eye exam.
  • Convenience — very often optometrists will share an office with an optician they trust, so you can choose your frame and lenses during the same visit – a one-stop shop. Also, locations with optometrists are more prevalent and more conveniently located.

An eye doctor is listed in my vision plan, but their office is telling me they will only accept my medical plan. What should I do?

Use your vision benefit plan where possible, not your medical plan. When you call to make an appointment, some optometrists might tell you that they prefer to use your medical health plan, not your vision plan. Don’t be afraid to insist that you will be using your vision benefit plan.

Finally, understand your coverage before you go. Check online with your vision benefit plan before you go to the appointment so you know what’s covered and what’s not, and what your costs might be.

MagnaCare and International Association of Fire Fighters Health & Wellness Trust Grow Benefits Administration Partnership

Expanded relationship extends national support for first responders

NEW YORK (Aug. 25, 2022)MagnaCare and the International Association of Fire Fighters Health & Wellness Trust have expanded their relationship to make high-value healthcare benefits available to first responders and their families nationwide. MagnaCare, a third-party administrator with deep expertise supporting Taft-Hartley trusts, serves as the TPA for all IAFF Health & Wellness Trust health plans, delivering administrative services and technology tools to support the trust’s rapidly growing member base.

Formerly known as Northwest Fire Fighters Benefits Trust, IAFF Health & Wellness Trust offers a slate of health benefit options specifically designed to meet the needs of firehouse employees and their families. Based in Washington state, the Trust currently serves more than 4,000 members in eight states. The Trust is expected to double in size in the next six months.

“We launched the Trust in 2013 to bring firefighters and their families comprehensive, affordable and sustainable health plans. We have experienced tremendous growth since then, and our recent rebranding and alignment with IAFF have further accelerated interest in the tailored health solutions we provide,” said Greg Markley, chairman of IAFF Health & Wellness Trust. “MagnaCare’s extensive knowledge and respect for labor groups, their willingness to integrate with our existing partners, and their proactive approach to bringing us innovative solutions make them the right partner for this next phase of growth.”

For more than 30 years, MagnaCare has been a trusted provider of third-party administration services to labor and other self-insured groups. Through its partnership with IAFF Health & Wellness Trust, MagnaCare provides benefit administration for all trust health plans, many of which use the Regence BlueCross BlueShield provider network. MagnaCare also delivers customer service, medical management, case management and telehealth support. The trust also leverages MagnaCare’s proprietary Create® Technology platform, which enables all aspects of health plan access, including tools for online open enrollment, benefits administration, and member activation and engagement.

IAFF Health & Wellness Trust and MagnaCare first partnered in 2018 for the state of Connecticut and extended the relationship in 2021 to five additional states.

“Our expanding relationship with IAFF Health & Wellness Trust is a testament to our mutual success to date and our shared commitment to making healthcare benefits access easier for first responders and their families,” said Michelle Zettergren, president of MagnaCare. “We look forward to collaborating to improve member experience while supporting the Trust’s rapid growth.”

 

About MagnaCare

For over three decades, MagnaCare, a national Third Party Administrator has been building healthy communities together with Taft-Hartley trusts, providers, other TPAs, carriers, and workers’ compensation and no-fault payors. Its wholly owned networks, full health plan management services, extensive trust and welfare administration services, comprehensive in-house medical management services, and leading outcomes-based casualty solutions offer the ultimate flexibility and customization that help clients simplify administration, control healthcare costs, improve health, and achieve exceptional value. MagnaCare is a division of Brighton Health Plan Solutions, LLC. Learn more at MagnaCare.com.

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Media Contact:
Erin George
[email protected]
615-946-9914

No Surprises Act Notice and Disclosures

Download PDF of No Surprises Act Notice and Disclosures

Rights and Protections Against Surprise Medical Bills for Emergency Services and Certain Services from Out-of-Network Providers at an In-Network Hospital or Ambulatory Surgical Center

Plan participants are protected from surprise billing, also called balance billing, for emergency care and claims from out-of-network providers that rendered certain services at an in-network hospital or in-network ambulatory surgical center.

Emergency Services

The most a provider or facility may bill a participant is the plan’s in-network cost-sharing amount (such as copayments and coinsurance). The provider cannot balance bill for emergency services. This includes services after a patient has been stabilized, unless the patient provides written consent and gives up protections from being balance billed for post-stabilization services.

Certain Services from out-of-network providers at an in-network hospital or ambulatory surgical center

Out-of-network providers at an in-network hospital or in-network surgery center that provide emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeons, hospitalists, or intensivists services, are not permitted to balance bill. They are not permitted to ask a patient to consent to give up protections against balance billing.

Out-of-network providers of other services at in-network facilities may only balance bill a participant if the participant gives written consent and gives up the protections from balance billing.

Contact

For information and complaints related to balance billing, contact the U.S. Department of Health & Human Services at 1-800-985-3059 or visit https://www.cms.gov/nosurprises/consumers for more information about the No Surprises Act, payment disputes and patient rights under federal law.

Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

More about the No Suprises Act

No Surprises Act introduces a new term called the Qualifying Payment Amount, or QPA, and defines it as the plan’s median contracted rate — the middle amount in an ascending or descending list of contracted rates. The most a provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). The law requires providers to accept the QPA as payment in full for out-of-network emergency services. In addition, certain services provided by out-of-network providers at in-network facilities are also subject to these protections unless the patient provides consent to be billed.

Infographic: Expand Your Network Reach

Offer your clients access to leading local and national provider networks, and lower their healthcare costs.

TPAs and carriers trust MagnaCare for high-quality, affordable network access. Rely on our expertise to:

  • Gain access to top-quality providers, with deep discounts and lower total cost of care
  • Customize your network with the locations and providers you want to access
  • Contract with providers and health systems to build unique networks for your clients
  • Provide cost-saving services that lower your clients’ healthcare costs, such as medical management and redirection of care services

View the infographic and contact us for more details about our network access offering.

Access Network infographic